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C' SAN JUAQUIN COUNTY <br /> NOTIM N OF 11AZARDOUS WAS HARGE <br /> TlI & SArETY CODE 2S1 <br /> A. EMERGENCY LEVEL: I I ,- PIE'S-EH LOG # <br /> (Circle One) <br /> B. SOURCE OF INFORMATIO <br /> Original Source: �-� � l Telephone: 15 (0 -7/— la <br /> Reporting Agency Name: <br /> Agency Contact: Telephone: <br /> Address: 0n 9/, siecn�c ,, fz± <br /> C. LOCATION AND DATE OF DISCHARGE <br /> Location: A`��_� b. 1�'�'� & a A / C <br /> (Best Physical Description) (City or County) <br /> Date of Discharge: Z-6-A <br /> Date Notified: Time: lO 'd OG"m� <br /> D. RESPONSIBLE PE SO' /BUSINESS <br /> Name of Business SAI L <br /> Contact Person: �TGtin.) Telephone: S <br /> Physical Address: <br /> Ce9 0 <br /> E. DESCRIPTION <br /> Type Release: <br /> Volume: - <br /> e <br /> Chemicals: �X�� <br /> F. ACTION TAKEN <br /> SS LU�t:� <br /> 17"'titew"' v <br /> a ` <br /> t <br /> ET Y 013 (Rev. 02/90) <br />